In an issue of first impression,  the Iowa Supreme Court  agreed with  the Commissioner   and District Court that an employer who had initially denied  liability for a claim, but then  subsequently  agreed to accept   the claim, was  able to regain  control over directing medical care, and consequently that   healing period benefits claimed from unauthorized care were not the employer’s responsibility. (Kelly Brewer-Strong vs. HNI Corporation, No. 16-1364, filed June 8, 2018)

The claimant alleged bilateral carpal tunnel injuries in her original notice and petition. The employer, in its initial answer to the petition, denied liability for the injuries. Employer then solicited a physician’s written opinion, who stated “I do believe carpal tunnel can be/is related to her work activities.” Employer still did not view this as definitive on the causation question and therefore denied claimant’s further request for medical care based upon that doctor’s statement.

Claimant then filed a petition for alternate care, seeking a ruling on further medical care and claiming an “abandonment of care”. Employer answered this petition still denying liability. The alternate care petition was therefore dismissed on procedural grounds because of the contested liability.  However employer subsequently obtained an examination and this time a different  physician opined that the injuries were in fact work related. Therefore, the employer amended its original answer to now admit liability, and authorized care with employer’s chosen medical provider.

However, claimant declined  the offered treatment, and instead sought treatment from a different unauthorized physician, who ultimately performed surgeries. Employer  on multiple  occasions communicated to claimant that it was  only authorizing care with  its examining doctor, and attempted to set up follow up  care with that doctor, but claimant refused. Employer also  cautioned claimant that  treatment with  any other doctor  was not authorized and that the  expenses would not be covered. In addition to the  unauthorized  surgeries and care, employer refused to pay healing period benefits for the time claimant was recovering from the unauthorized surgeries.

In upholding the  availability of employer’s authorization defense, even after its  initial denial of liability, the Court explained that to hold otherwise would be contrary to  the purposes of the Act, and that an employer should be encouraged to  continue to investigate and monitor claims, and  to have the opportunity to change its  position to accept liability.

In affirming the denial of the unauthorized medical expenses and healing period benefits, the Court declined claimant’s invitation  to lower the standard for a claimant to  prove employer liability for unauthorized medical care and healing period benefits. The standard, established in Bell Bros. Heating & Air Conditioning v. Gwinn, 779 N.W.2d 193 (Iowa 2010)  is that  a claimant must show such care provided “a more favorable medical outcome than would likely have been achieved by the care authorized by the employer.“   Claimant’s surgeon had testified in deposition that  he was unable to say that the care he provided  would be any different than that  of the  authorized  physician, or that his treatment provided a more favorable outcome. Claimant herself  testified that  she  was unsure if she was satisfied with the results of the surgeries  by  the unauthorized physician.

This case illustrates the importance of  the  employer  and carrier to continue to  monitor and investigate liability for initially denied claims. Further, once liability is accepted, the employer should clearly  communicate to the claimant what care is authorized, and  that  unauthorized care will not be  covered.

Thanks to I&F Partner Terry Donohue for thus summary of this case.  Terry handles Iowa claims for the firm and works out of the Chicago and Des Moines offices of Inman and Fitzgibbons.  Please feel free contact Terry with any Iowa workers’ compensation questions.